Noma: A Neglected Health Crisis

Context:

This analysis is written in the wake of World Oral Health Day on March 20, it explores noma, a severe gangrenous disease recently classified as a neglected tropical disease by the WHO in December 2023. The piece details its impact, stages, and prevention, offering critical insights into public health challenges in impoverished regions as of March 24, 2025.

1. Definition: Noma, also called cancrum oris or gangrenous stomatitis, is a non-contagious, severe disease that rapidly destroys mouth and facial tissues, primarily affecting malnourished children aged 2-6.
2. WHO Status: Classified as a neglected tropical disease (NTD) by the World Health Organization in December 2023, highlighting its link to extreme poverty and poor health systems.
3. Prevalence: Most common in sub-Saharan Africa, with historical presence in Europe and the U.S. until the 19th century, eradicated there due to improved welfare; exact case numbers are elusive due to rapid progression and stigma.
4. Stages of Progression: Five WHO-defined stages—Stage 0: simple gingivitis; Stage 1: acute necrotising gingivitis; Stage 2: oedema; Stage 3: gangrene; Stage 4: scarring; Stage 5: sequelae—starting with gum inflammation and escalating to tissue destruction.
5. Symptoms and Risks: Begins with intraoral ulcers or necrotising gingivitis; untreated, it spreads to soft and hard facial tissues, causing disfigurement and high mortality (up to 90% without intervention).
6. Causes: Linked to malnutrition, poor oral hygiene, weakened immunity, and concurrent diseases like measles, HIV, or malaria; it’s an opportunistic infection, not a specific pathogen.
7. Historical Perspective: Known since antiquity, documented in 1649 by Arnoldus Bootius; declined in developed nations by the late 19th century as living standards rose, per a 2017 study in the American Journal of Tropical Medicine.
8. Challenges in Detection: Rapid progression, high fatality, weak surveillance, social stigma, and low awareness among healthcare workers hinder accurate case estimation and timely intervention.
9. Prevention Strategies: Includes food security programs, measles vaccination, treatment of coexisting illnesses, and surveillance in marginalized communities, as outlined in a 2024 paper.
10. India Relevance: Though rare, noma’s association with poverty and malnutrition aligns with India’s public health priorities, emphasizing the need for oral health awareness and early detection.

Key Terms:

• Noma: Severe gangrenous disease of the mouth and face, tied to poverty and malnutrition.
• Neglected Tropical Disease (NTD): Category of diseases, including noma, prevalent in poor regions, recognized by WHO.
• Cancrum Oris: Alternative name for noma, meaning "mouth cancer" in Latin.
• Gangrenous Stomatitis: Medical term for noma, indicating tissue death in the mouth.
• Acute Necrotising Gingivitis: Early stage of noma marked by gum infection and tissue breakdown.
• Malnutrition: Poor nutritional status, a primary risk factor for noma.
• Social Stigma: Shame or isolation linked to noma’s disfigurement, delaying treatment.

Link To The Original Article – https://www.thehindu.com/sci-tech/health/all-you-need-to-know-about-noma/article69361065.ece